Q&A: AMA’s chief health equity officer on ridding medicine of racial essentialism

In the aftermath of the police murder of George Floyd and subsequent Black Lives Matter protests across the U.S. in 2020, many institutions confronted their own histories of racism, lack of diversity, and failures to consider the impact of structural inequities on public health. That process was already underway at the American Medical Association, spearheaded in large part by Aletha Maybank, who was hired in 2019 to launch the organization’s Center for Health Equity.

Maybank, a physician who previously served as the founding deputy commissioner for the New York City health department’s Center for Health Equity, has kept pushing to transform the culture of health care via her work at the AMA — whether by promoting health equity education for health care providers or fostering partnerships with large health systems through the Rise to Health Coalition to address issues like disparities in maternal mortality rates. Maybank also moderates the AMA web series “Prioritizing Equity,” which started with a focus on the stories of physicians who prioritized equity in their Covid response efforts.

Maybank, one of 50 people chosen for the 2024 STATUS List recognizing leaders in health, medicine, and the life sciences, spoke with STAT about her team’s accomplishments, challenges, and what she looks forward to achieving in the future. This conversation has been edited for clarity and brevity.

How did your work as deputy commissioner for the Center for Health Equity at the NYC Department of Health and Mental Hygiene inform your role at the AMA?

I came from the leadership of [former New York City Health Commissioner] Mary Bassett, who really set the foundation — at least at the government level — about the impacts of racism on health being the fundamental cause of health inequities. She leveraged her platform at the New York City Department of Health as well as research and data to really push that narrative and reality forward.

My skill set is doing startups within the context of institutions. I’ve started an Office of Minority Health [at the Suffolk County Department of Health Services in New York]. I’ve started a Center for Health and Equity in the largest health department in the urban world. And I started the Center for Health Equity here. I’ve also helped support and advise the [Centers for Disease Control and Prevention]; I was a CDC adviser for 18 months to support their internal work as it relates to advancing equity and racial justice within the organization.

So that’s my skill set that I brought with me. And that’s probably what the unique part is: that internal piece, the organizational change work, to advance equity in order to drive how we do work on the outside and with others, is really key and essential and hard.

I was reading about the racial reckoning at the AMA, and it looks like it has taken a while from 1989 to now to get to this point. Do you wish that these changes were happening faster?

We were all helped by the realities of Covid and exposure of inequities, as well as the public murder of George Floyd. And clearly it wasn’t helpful in the sense of increased and continuing police brutality. But we are very well aware that racism was talked about in a way that never had been.

And then the House of Delegates [the AMA’s policymaking body] also capitalized on that moment, too, in putting forward a pledge regarding antiracism and naming racism as a public health issue, but more importantly, ridding medicine of racial essentialism, stating that race is a social and not a biological construct. That’s important from a policy and scientific level to actually have codified in the policy of AMA. Removing race as a proxy for genetics and biology and research — that, to me, is the tremendous win of the time.

But the AMA still has its challenges on policies that still don’t fully support equity in the mindset of many. And like any institution that has been around for 176 years now, it’s an institution that is created under and with a white supremacist lens. But that’s the entirety of medicine. And so there is no institution in this country that has been predominantly white or historically white that doesn’t suffer from those realities.

I try to really ground myself and ground young people in the sense of what creates hope — that we’re part of a legacy of people who believe and know that they deserve dignity; they are of value and we all deserve love as well. And that legacy is a beautiful legacy. It’s a painful legacy, and an exhausting legacy.

What changes are you most proud of during your tenure?

I would say our big document that we put out in 2021, the AMA equity strategic plan, definitely generated much attention [and] really set a clear foundation and grounding for where we needed to go as AMA. And I think it influenced the larger aspect of medicine.

I’m also very proud of some of our larger-scale initiatives such as Rise to Health, which is a true partnership with many entities within the ecosystem of health. We have some lead racial justice partners, such as Race Forward and PolicyLink and Groundwater Institute, to keep us accountable. We’ve seen the rewards come back when you see regulatory folks — we’ve partnered with the Joint Commission at some point — are influenced, and they expressed they were influenced by the partnerships with us to evolve how we use race within clinical algorithms.

I think the other big reward was around our narrative guide, which came out after the strategic plan. And this was really a tremendous tool for physicians to know how to use language and understand how language impacts actions. We know many med schools actually have embraced it, and have adopted it into their curriculums. We know some pharma [companies], it’s become part of their communication guides; federal agencies, as well.

A large part of our work that we’re now embarking on is our work towards truth, reconciliation and healing; really fostering pathways for the harm that we have caused. Definitely some of it was highlighted in our strategic plan, but now we have a task force looking at our history, hearing testimony from across the country. We’ll provide recommendations to our Board of Trustees within two years or so on the next steps to embark on.

As a physician and as a Black woman, do you think that your career path feels like a full circle moment?

Some people would say, “This is not my father’s AMA.” And I’m like, “Yes, it wasn’t my father’s; my father wouldn’t have been in the AMA or gotten in there.” But the point is: Has there been lots of change in the context of AMA? Of course. However, injustice is injustice, exclusion is exclusion, harm is harm. And for all the years of early death and suffering — from the time of settler colonialism and the colonizers came over to grab land, to commit genocide amongst and towards the Indigenous people, and the capture of Africans brought here to be enslaved — all of it is too late. So what has to happen?

There’s a great quote that Isabel Wilkerson has in the book “Caste”:

“Many people rightly say, ‘I had nothing to do with how this all started. I have nothing to do with the sins of the past. My ancestors never attacked Indigenous people, never owned slaves.’ And, yes. Not one of us was here when this house was built. Our immediate ancestors may have had nothing to do with it, but here we are, the current occupants of a property with stress cracks in bowed walls and fissures built into the foundation. We are the heirs to whatever’s right or wrong with it. We did not erect uneven pillars or joists, but they’re here now to deal with now.”

And so I use that, because I don’t feel the burden of this work should be upon us as Black and brown people and those who’ve been historically marginalized. There’s no way we accomplish justice without more people stepping up to be accomplices, and understanding that they’re in this house as well. How do we build that? How do we encourage that momentum beyond the context of allyship? Allyship, to me, is passive. We need accomplices. We all need to be stepping into this together if we’re really committed and have the will for justice.